’ve been reading a lot lately about how the “chemical imbalance” theory is not at all supported by scientific evidence.
As
@Vee says, 'chemical imbalance' is such an over-simplification as to be nearly meaningless. A number of years ago, when the research was still in it's very infancy, describing it as a chemical imbalance made a kind of sense...laypeople could understand it, and it neatly hopscotched over the chunks of science that didn't exist yet.
Now that the science is more advanced, and there's more data - still, really, in it's baby-hood - there's enough to see that it's not as simple as an imbalance.
Other things that we know is that the longer you are exposed to stress, the more likely antidepressants are to work for you. Antidepressants don't have a great track record for people who are mildly depressed or mildly anxious...but they have a pretty good track record for those with major depression and major anxiety issues. It is probably the chemicals produced by stress that cause the disruption between the synapses and the "chemical imbalance."
I have a slightly different mental picture of this, and if I could source it I would, but it's from a big swath of various research studies and other sources. There seems to be an optimal window for depression treatment with SSRIs, and it's something like 'not mildly depressed, but not pervasively depressed'. They can be helpful for a chunk of the population, but despite the various refinements/alterations in mechanisms of action, they are still pretty random.
Pervasive depression responds better to SNRIs, but those drugs are also more intense. Rarely used as a first-line Rx for depression that is moderately severe, but quite common as the initial prescription for depression that is more than moderately severe, or coupled with a genetic load, or happening to certain genders in certain age brackets...there's no true objective measure. And now we have the early stages of genetic marker testing, which adds more refinement to the process, though still does not predict what medication will actually work.
And then there are all the other classes which may be used either as clinically approved or off-label solutions, or as adjuncts. Plus the importance of cognitive work...
It's also worth pointing out that depression experienced as a PTSD symptom and depression as a stand-alone disorder are two different things. They respond to medication differently. But PTSD is also something that has a very wide spectrum of symptoms, and C-PTSD makes this even more complex. Depression is also not a single disorder.
The more they study, the more they learn, and it inches along. These drugs all generally do
something - and that includes, having a placebo effect - it's just that without far more detail in our scientific understanding of the brain, mood, trauma, neuroplasticity...without a full and complete picture of how it all works, there cannot be a full and complete understanding of how it is impacted by various drugs.
Until that day arrives, we'll all continue to do what we are willing/able to do as individuals to get relief, and hopefully do it with doctors who are as educated as they can be on where the research is at.
